Faye Abdellah's 21 Nursing Problems

As part of Abdellah's patient-centered approach, she comprised a list of 21 nursing problems which are
patient specific problems that a nurse can identify in order to help them organize their nursing
interventions. The 21 nursing problems were subdivided into 4 levels of needs. Level 1 is the Basic
needs. These are needs that are common to all patients which are basic human necessities. The
problems are related to comfort, hygiene and safety of the patient. Level 2 are the Sustenal Needs.
These are usually overt problems. Problems with the physiological body processes. It is said that these
are identified through direct approach. It comprises of numbers 5 through 11 of the 21 nursing
problems. The third level is the Remedial needs. These are problems related to emotional and
interpersonal difficulties which can be identified through indirect approach. The last and fourth level are
the Restorative Needs which are sociological or community problems or to put it simply, environmental
factors. The main strength of Abdellah’s theory comes from the fact that it provides nurses a better
foundation for establishing, organizing and providing care. It comes of as a sort-off “to-do list” The
problem also comes from its strength. If for example, a nurse fails to provide care on one part of the list.
Does that mean that the nurse has been ineffective? No matter the outcome of the patient, n the
theory’s point of view, if the nurse was not able to fulfill everything on the list, then he/she was not able
to successfully do the job. Furthermore, the theory focused more on the patient as an individual. The
theory will not hold much ground for community level assessments. A potential research topic could
include terminal patient cases. Abdellah’s theory ended in the restorative part. But what if there is no
longer hop for restoring the patient’s health? What care can one provide? We all know that the end
result of such terminal disease is death. Maybe a 5 th level is necessary to bring into play in order to
address the end-of-life care that a patient may need.

Hildegard Peplau’s Theory of Interpersonal Relations

Peplau’s background in psychiatric nursing greatly influenced this theory. She placed great significance
to therapeutic care that a nurse provides. The concept of nursing as defined by the theory states that
Nursing is a significant therapeutic interpersonal process that functions cooperatively with other human
process that makes health possible for individuals and communities. The theory notes that best way to
help patients is to establish good inter-personal relationship with the patients. Just like with any other
relationship, the relationship has to be a partnership with a give and take flow. Peplau noted 4 phases of
the nurse-patient relationship. The first phase is the orientation phase which is directed by the nurse. It
involves engaging the client in treatment, providing explanations and information and answering
questions. It is also known as the problem defining phase where the nurses are doing their assessments
based on answers given by the patient. The second phase is the Identification phase. This begins when
the patient works interdependently with the nurse to express feelings and begins to feel stronger. The
patient begins to have a feeling of belonging and a capability of dealing with the problem which
decreases the feelings of helplessness and hopelessness. Third is the Exploitation phase wherein the
client makes full use of the services that are being offered by the nurse. The client may make minor
requests or attention getting techniques. The nurse, in turn, aids the patient in exploring all angles that
could help the patient progress. The fourth is the Resolution phase. In this phase, the client no longer
needs professional services and gives up dependent behavior. Per the theory, this marks the termination
of the professional relationship of the nurse and the client. The patient needs have already been met by
the collaborative effect of the patient and the nurse.
The main strength of this theory is that each phase is very simple and easy to follow. However, it does
not provide holistic care. Therapeutical care has its own advantage but it fails to provide the
physiological care that the patient needs. It is much more ideal in a psychiatric setting rather than a
hospital setting.

A good approach for a thesis is how to apply this theory to patients that are withdrawn or is under
severe trauma. How will the nurse start the relationship? Or how about for comatose patients? What
kind of relationship will they have? As mentioned earlier, this is a give and take relationship. How to
proceed then if the patient is unconscious?

Erik Erikson’s Theory of Psycho-social Development

Erikson’s theory identified 8 stages that a person goes through from birth to death. Each stage
encounters different needs and encounters different scenarios and challenges which influences the
behavior. The first stage is called Trust vs. Mistrust. As an infant is quite dependent, they learn to trust
or mistrust others. If an infant experiences fear or if needs are not gratified, the infant develops doubt
and mistrust. This stage lasts from infancy to 18 months. The second stage is Autonomy vs Shame and
doubt. The child discovers his body. It tries to discover itself and if allowed, the child develops self-
confidence. If not allowed, the child develops shame or self-doubt. Stage lasts from 18 months to 3
years of age. The third stage is Initiative vs. Guilt. In pre-school, the child takes initiative and tries new
things. The child tests his limits and wonders if it is okay. If encouraged, the child will follow his interests
and likes. If held back or told that what he is doing is wrong, the child develops guilt. The stage lasts
from 3-5 years. The fourth stage is called Industry vs Inferiority which lasts from age 5 through 12. At
school age, the child realizes they are different from others. They want to show that they can do things
right. If recognition is received, the child becomes hard working. If discouraged, the child feels inferior
and lacks motivation. The 5th stage is Identity vs Role Confusion. During adolescence, different social
roles is learned. If allowed to go out and explore, the child develops his/her own identity. If not, or
pressed to follow the norm, the child faces role confusion and may feel lost. The stage lasts from age 5
through 12. The 6th stage is Intimacy vs Isolation. This is also called early adulthood. The person starts to
understand who they are wonders if he/she can love and can make a long-term commitment. If intimate
relationships are not formed, the person might feel isolated and lonely. The stage lasts from 18-40
years. The 7th stage is Generativity vs. Stagnation. When adulthood is reached, the person starts to
contribute to society. The concern is generativity. If the person thinks that they are able to lead the
future generations, then they become happy. If conflicts are not resolved, the person becomes
pessimistic and experience stagnation. The stage ranges from 40-65 years. The 8 th and last stage ego
integrity vs Despair. This stage is called maturity which ranges from age 65 until death. As the person
grows older, they tend to settle down and starts to look back over their lives. The person evaluates
himself and the achievements they have made in their lifespan. If they think they did well, they develop
feelings of contentment and integrity. If not, they become despair and becomes grumpy and bitter.

The strength of this theory is that, unlike its predecessor (Freuds psychosexual theory), it spans the
entire lifetime of the person. It’s ability to capture the influence of its peers at the time of the stage is
encountered is very much precise. It not only looks at the social but also the cultural influences on the
outcome of the behavior of an individual. Its weakness is that it focuses more on childhood stages and
just skipped through the adult life. As a person, we intend to grown and change depending on our life
experiences. It’s not always one thing or another. There are always factors throwing us into a whole
different angle. Further research on adult behavioral determinants could provide a good addition to this
theory.